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Association of professional identity, gender, team understanding, anxiety and workplace learning alignment with burnout in junior doctors: a longitudinal cohort study
  1. Lynn V Monrouxe1,2,
  2. Alison Bullock3,
  3. Hsu-Min Tseng1,4,
  4. Stephanie E Wells5
  1. 1 Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital Linkou Branch, Linkou, Taiwan
  2. 2 School of Medicine, Chang Gung University, Linkou, Taiwan
  3. 3 CUREMeDE, Cardiff University, Cardiff, UK
  4. 4 Healthcare Management Department, Chang Gung University, Linkou, Taiwan
  5. 5 School of Medicine, Cardiff University, Cardiff, UK
  1. Correspondence to Professor Lynn V Monrouxe; monrouxe{at}


Objectives To examine how burnout across medical student to junior doctor transition relates to: measures of professional identity, team understanding, anxiety, gender, age and workplace learning (assistantship) alignment to first post.

Design A longitudinal 1-year cohort design. Two groups of final-year medical students: (1) those undertaking end-of-year assistantships aligned in location and specialty with their first post and (2) those undertaking assistantships non-aligned. An online questionnaire included: Professional Identity Scale, Team Understanding Scale, modified Hamilton Anxiety Rating Scale and modified Copenhagen Burnout Inventory. Data were collected on four occasions: (T1) prior to graduation; (T2) 1 month post-transition; (T3) 6 months post-transition and (T4) 10 months post-transition. Questionnaires were analysed individually and using linear mixed-effect models.

Setting Medical schools and postgraduate training in one UK country.

Participants All aligned assistantship (n=182) and non-aligned assistantship students (n=319) were contacted; n=281 (56%) responded: 68% (n=183) females, 73% (n=206) 22–30 years, 46% aligned (n=129). Completion rates: aligned 72% (93/129) and non-aligned 64% (98/152).

Results Analyses of individual scales revealed that self-reported anxiety, professional identity and patient-related burnout were stable, while team understanding, personal and work-related burnout increased, all irrespective of alignment. Three linear mixed-effect models (personal, patient-related and work-related burnout as outcome measures; age and gender as confounding variables) found that males self-reported significantly lower personal, but higher patient-related burnout, than females. Age and team understanding had no effect. Anxiety was significantly positively related and professional identity was significantly negatively related to burnout. Participants experiencing non-aligned assistantships reported higher personal and work-related burnout over time.

Conclusions Implications for practice include medical schools’ consideration of an end-of-year workplace alignment with first-post before graduation or an extended shadowing period immediately postgraduation. How best to support undergraduate students’ early professional identity development should be examined. Support systems should be in place across the transition for individuals with a predisposition for anxiety.

  • mental health
  • anxiety disorders

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  • Contributors LVM and AB contributed to the conception of the study; LVM, AB and SEW designed the work; SEW contributed to the acquisition of the data; H-MT and LVM contributed to the analysis of the data and all authors contributed to the interpretation of data; LVM and SEW drafted the manuscript, all authors revised the manuscript critically for important intellectual content; all authors gave their final approval of the version to be published; all authors agree to be accountable for all aspects of the manuscript and will ensure that any questions relating to the accuracy or integrity of any part of the manuscript are appropriately investigated and resolved.

  • Funding The study was partly funded by a small research grant from the Association of the Study of Medical Education (ASME) and partly by the School of Medicine, Cardiff University, who have been kept informed of progress with the collection, analysis and interpretation of data but the researchers remained fully independent from the funders.

  • Competing interests None declared.

  • Ethics approval School of Medicine Research Ethics Committee at Cardiff University (reference no: 15/08).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data are available outside the research team.